Hi All, I was on 150mg ERFA and increased to 157mg for 3 weeks. I am now over-medicated, with high heart rate and blood pressure.
But, what's the best way to manage this? I have decreased to 120mg for the last 4 days and am still feeling very hyper. My plan is to go back to 150mg as soon as possible, but I feel awful. Do I stay at 120mg - if so, for how long? I can't tolerate 150mg, but if i stay at 120mg for too long, I'll start getting hypo symptoms.
Thanks,
Eve
Just 7 mcgs. caused this? How long were you at 150 before the addition? Personally I would stop everything for a few days. You will still have plenty in your system although T3 will reduce more quickly. You'll have to figure out what your optimal dose should be. I'm sure you will get other opinions.
Heloise, 7.5mg of NDT, yes 
I was at 150mg for about a year I would say, but was feeling hypothyroid this winter and increased because of that. In retrospect, it could very well have been high stress instead of hypothyroid I suppose. I was feeling very cold and tired. But, I also had a UTI that wouldn't go away for months, and then in January I broke my arm. Do you think it could be adrenals instead?
Today was a horribly hyperthyroid day with heart rate over100 and blood pressure around 140/90. My normal heart rate is about 80, and blood pressure 120/80. I felt loads of anxiety as well.
I only took 60mg today, and will not take any more Any NDT at all just made my heart rate and blood pressure too high. I think tomorrow will try taking none.
Hmmmm, now that you've added all the stressers I do wonder if it is adrenal and if it is you may need to stay on thyroid hormone. Your adrenals react and put out adrenaline and you may feel hyper. Stress raises cortisol and puts you in a fight or flight state.
Grey asked if you had antibodies. If you are having an antibody attack you will get a flood of hormone as I understand it. That will also make you feel hyper. I know one thing when I was low, my heart would beat hard and slow in the night. I was very low. I'm just not sure whether those are hyper symptoms now. You could skip one more dose and see what happens.
I've got a saliva cortisol test on order, but it'll take 2 weeks to get results i would think. I don't know if I have antibodies because my doc won't test. It's so hard to know what to do in the meantime, but I think I should see if no NDT for the next day and see if that will make me feel better or worse. It's 8:30pm here, and my heart rate and blood pressure are both a bit better - still not good, but they are better. Heart rate is about 85 and blood pressure about 130/85 or so.
Do you know of any way to manage the symptoms in the meantime?
Some simple things to try to relax because of what cortisol is doing. It increases muscle tension and that hinders blood supply. Breathing techniques long inhale, hold and then exhale very slowly. You can clench muscle and release in different areas. Calcium and magnesium supplements help, you could take that at bedtime. You have to look at this as a whole body problem. If you can handle sulfer, epsom salt soaks also help. Ashwaganda and dandelion tea can be helpful. Are you following anyone's book like Izabella Wentz'. I like the STTM website.
stopthethyroidmadness.com/l...
Hi Heloise, Thanks for your suggestions. I follow stop the thyroid madness and have her books. I will try the Calcium and Magnesium. Am already doing the breathing techniques.
That's wonderful. There is a relaxation response which is very healing if you can get there. There are cds which have binaural beats which can help you achieve it. You can actually find some on you tube and if you can use ear phones, that's best. Some people get very good at it.
When you are stressed your body won’t convert t4 to T3 easily. I was recently hyper and experienced many of your symptoms. I cut back my dose over a few weeks, which helped until my body rejected the levothyroxine all together. In which case I stopped taking it overnight. I now have adrenal fatigue (which may have been the problem all along). Working on restoring my health through Dr Lam. Not currently on any medication. I understand fixing your adrenal issue is very important and should be done before sorting out your thyroid.
Hi Tardisnz, makes sense. Are you seeing Dr. Lam and are they helping? How are you supporting your adrenals?
Just bought his book, and left him a message. I scored 7 on his online test. Not sure if that's significant or not.
Do you have high antibodies?
greygoose. I don't know if I have high antibodies right now. My doctor won't test them, saying they wouldn't have changed. I had antibodies tested last year, but they were ok then.
I know exactly what you are feeling all those werid thought& stress, go up on the web you should find a site that has over medicate thyroid i found out mine 3 months ago and i still have some , but getting better i was told to go back to the dose before the upgrade i couldnt do it i cut the tab in half and took it for a week the doctor wasn`t thrilled said i should have not done it i week later i started taking the regular pill and some times take half my tsh went up a litter high but not bad and i still have some side effects but they will lease soon so i would say i know their pain it will work out from linda over the ocean in calif
Hi Linda. Thanks for your reply. Sorry to hear you went over too. The symptoms are quite awful, aren't they?
I sometimes feel this way...the slightest deviation form normal everyday stuff can set me off..I suppose ultra sensitivity to adrenaline, I usually end up having a major optical migraine which alerts me to calm down, stop letting things bother me so much. That said, I find if I use a magnesium sport spray on upper arm region helps calm and aid sleep. I dont trust or involve any medics in my condition any longer and once I got my head around the fact that this is my body, my condition and I am treating myself without any misguided 'help' from the medical profession, strangely things improved for me (after a long time of mucking about with different NDTs and differing doses) For me it's all about experimentation and having confidence in my own instincts.
Thanks for your suggestion. Where do you get magnesium sports sprays? I have to agree regarding "medics".
Hi...I bought some 'Transdermal Magnesium Chloride Spray' online quite a while ago after a recommendation. I think since then there are a number of other choices, many just seem to call it Magnesium Oil, but I read that it is better absorbed transdermally and can have an instant effect. Another person commented in a blog that she bought Magnesium Flakes (Epsom Salts if you will) and either bathed in them or dissolved them in purified water and used as a spray....I have a bag of these and will make up my own spray when I run out, much cheaper. I dont like taking too many things orally and as already take vits D and K etc so spraying suits me for that reason also. 
Will see if I can find some. I do take Calcium/Magnesium when my heart rate is out of control and it does seem to help. This sounds better.
Evej13, a 7mg increase of NDT is extremely small. It's like something like 9mcg of Levo, or 2 or 3mcg of T3.
So it's unlikely that that's the culprit if you're feeling terrible days after reducing.
I think it's more likely to be a Hashis flare up that's making your hyper for a short time.
It's okay to give up all hormone if you want to - nothing bad will happen to you. Then the moment the hyper feeling goes away start back on 150 again. On NDT you'll be running mainly on T3, that is very fast acting and will pick you up again very quickly.
SilverAvacado, I have to agree. It's such a TINY increase, yet it clearly has me over-medicated as my heart rate is over 100 and blood pressure is also elevated (140/90). I was on the increased amount for 3 weeks, so I hope it doesn't take too long for my body to readjust.
How do I know if I'm having a Hashis flare up if my doctor won't test for antibodies? Do I just assume that's the case? And if so, what do I do about it?
I took my first two doses of 30mg yesterday, and felt very hyper all afternoon and evening. I didn't take any more after that, and finally felt somewhat better around 9pm.
I was thinking of going to NO NDT for a day or two and then try to go back to 150. Does that sound like a good plan?
Yes, I think it does sound like a good idea. NDT contains both T4 and T3, and the T4 has a half-life of almost a week, so it takes ages to slowly wash out.
If I were you I'd go down to nothing for a few days. You can wait until the overactive symptoms have settled down, if you like. And if you feel undermedicated or hypo at any point, just start taking it again straight away.
If you haven't been tested for antibodies you don't know 100% if you have Hashimotos. Although its very likely you do, as 90% or more of hypothyroid people do have it. If you'd like to know for sure you can get a finger prick blood test from BlueHorizon or Medichecks.
I think the only way you can know if it's a Hashi's flare is by trial and error. It sounds likely to me, because it's hard to believe a small increase could make you feel so overmedicated. All you can do is keep going, and get more experience with your illness. I don't have Hashi's myself, so I haven't looked into it. It doesn't get discussed much on the forum
The treatment is the same as if it's over medication - cut down on hormone replacement for a few days, and hang in there until you feel better. Some people have a flare of some kind quite often.
SilverAvacado. I took only 60mg yesterday, and nothing today so far (it's only 9:30am here). I was tested for antibodies about a year ago, but can't find those results. I'd like to know for sure, but I'm in Canada and can't order any tests myself.
It's very hard to be patient when feeling like this!
Thanks so much for your response.
Maybe you can persuade your doctor to do another. You could mention you wonder if you've had a flare up, but many doctors kno so little they won't know about them
Ha! Agreed. Yet they THINK they know all. I am going to try to find another doctor, but I have heard they are currently getting in trouble here for ordering "unnecessary" tests, so may have to go back to a doctor I've seen about 6 hours away.
So far I feel quite a bit better than yesterday, with heart rate around 90 and BP around 130/80 instead of 100 and 140/90. Crossing my fingers!
Hi... After day 2 with almost nothing - 60mg mg first day, 30 the second, I am still feeling hyper this morning. Do I try another day or do I go back up to 90 or so?
Do would try a day with nothing at all, and stay on nothing at all until you actually feel different.
It won't hurt you to go without hormone for a few days.
Although the longer this goes on for, the more it seems like something else besides the dose increase that's an issue. If it's possible to do it fast enough, it would be great to have a blood test ASAP
Hi SilverAcvacado. I have taken nothing today. I feel better this evening, but I felt better yesterday evening as well. I wake up feeling anxious with highish blood pressure and heart rate. It settles down a bit in an hour, starts up again around 11, and stays that way all afternoon. Do you know if there's a cyclical conversion of T4 to T3 naturally?
This is Day 3 where Day 1 was just 60mg, Day 2 was 30, and today nothing. I can't figure out why I would still be feeling so hyper!
I had blood drawn today. Hopefully will get results tomorrow or next day.
Thanks for all your advice. Much appreciated.
I'm not sure about cycles in conversion. I know TSH is one big cycle for the whole day, and I think cortisol is, too.
Good luck! It will be good to see the blood test and clarify a bit what is happening.
Thanks SilverAvacado. Still waking up very early with high pulse and blood pressure. I will try to go see a doctor today. Have you ever tried beta blockers?
I can never understand it's ok to stop medication for a few days. I feel terrible if I go and hour over my due time for T3, sweating profusely and feeling sick, getting really cold too. I'm never convinced I absorb very much though! I felt agitated for a few weeks, I had lost 2 1/2 stones so thought I must be overeducated. My temps were still normal though, it was just agitation. Already I'm getting cramps in my legs and toes, and my temps are below normal. I take NDT and T3.
I also feel bad if I miss a dose. But I think everyone is different, and symptoms are more important. When I was on Levo and T3 I used to feel a lot better if I missed doses!
Are you alright? Do you think you might be having a flare up, too?
I have a lot going on that is making me anxious. I'm on an urgent list for surgery at the moment that, is going to cause a lot of pain after.
I never feel like I absorb anything well, still have a lot of hypo symptoms. I dropped the dose because I've lost weight, but probably dumped too much too fast! My temperatures never went over normal, and I certainly didn't get a fast heart rate or diarrhoea! Just increased anxiety and restlessness.
I'm similar. The hormone doesn't really make much difference 
I have raised a lot over 30 months, and I'm now about 20% activity level. So I can walk around the house most of the time.
Good luck with your operation x
I don't understand when people say they have more energy when they take thyroid meds. But over the last 5 years on NDT plus T3, I've gone from always looking for somewhere to sit and rest, and not being able to walk and talk at the same time, so there is some progress. I think the longer you've been left hypo, the longer it takes for any improvement. I'm grateful that my GP leaves me to it, and I dose for symptoms not for blood test results! 
I hope you find your way through this minefield! X
Hi helcaster, 2 hours after taking NDT I feel much worse, so think I must be quite a bit over. I feel bad whether I take it or not right now.
I felt awful when starting NDT, it's the only thyroid med that made me feel something was happening. But I just stuck with it and after 5 years since I changed from levo, I'm better on it. My temps didn't even rise from the mid 35's to normal on levo after 2 years. Every time I raised NDT I felt terrible for at least two weeks, but then things settled again. I take 3 grains.
Can you try drinking coffee, or anything that stops absorption? All I can say is if you feel over-medicated reduce slowly. Hopefully in a few weeks you'll start feeling more in balance.
Hi Evej13. I completely believe that a small dose increase like that can put you into a hyperstate! It has happened to me several times. Even increasing 2-5 mg can put me over. Taking any thyroid meds will put stress on our adrenal glands so its easy to push them over the edge also. I would suggest to stay on a lower dose for at least a week to 2 weeks but don't go off completely. It would take me 2-3 weeks to balance out again. When you go off completely it really throws your body into a tailspin. Our bodies are ultra sensitive to any hormonal deviations and it sounds like you are probably at the top of the range with 150 mcg of thyroid meds as it is. When you lower your dose , that alone will help your adrenals. I would suggest to stay away from any adrenal glandulars because they will take over your own adrenal production and stop what your body is producing. They are a natural hydrocortisone. I was on 75mcg. of thyroid meds for 30 years and had no problems whatsoever until they doctors started raising my dose over a four year period, ended up at 125mcg and crashed my adrenals. I was put on adrenal glandulars, made my life hell and now its been a year off of the glandulars and been back at 75mcg and it has taken a year to get my life back. I found out that my lack of energy and foggy thinking is from Pernicious anemia(b12 deficiency) and Iron deficiency and menopause not my thyroid. I too have tried to push my thyroid a little and always end up hyper, which is HORRIBLE! I am starting to get some energy back supplementing with b12, iron and folate. Which, by the way seems to go along with Hashimoto's thyroiditis. Hang in there. You will have some rough days and nights but it will get better. I think, maybe going down to 120mcg for a few weeks may do the trick. And maybe try 1/2 in the am and 1/2 in the pm so you're not taking it all at once.
Thank you jpar! Although awful you had to go through this too, it helps to hear someone else has had the same problem with a mico-increase.
I couldn't get past 60mg ERFA yesterday without truly awful symptoms. So far today is much better, but I haven't taken any meds yet.
I tried adrenal glandulars several years ago and had the same problem. It seemed to put me into hyper-drive.
Did you get your B12 and iron tested? I have asked for those tests here and they won't order them - something about "unnecessary" tests, and say I should just supplement B12.
I was splitting my NDT dose into 3, taking 60mg first thing in the morning, 60 at 2pm and 30 at 7pm. I only increased it to 157.5 because I was feeling horribly cold and tired. It appears as if it wasn't thyroid, but rather something else. I just don't know what!
I did have a stubborn UTI in November that took 2 months to resolve, and then broke my arm in early January. MAYBE it simply had to do with that? I really don't know.
Did you take antibiotics for the UTI?
Yes I did. Ended up having to take 3 courses to kick it out. Two different kinds.
B12 and iron can be a big factor in autoimmune thyroid. I would go to another doctor and get these tests done. And definitely add ferritin to the iron test.
I will see if I can find a doc who will order these but no luck so far.
Evej13, I can't remember if you said where you are in the world. In the UK we can order mail order private tests, but I suspect you are somewhere else as you're having NDT prescribed.
Stop the thyroid madness has details for ordering your own tests in the US, and you may be able to search and find things wherever you are.
In a situation like this it's hard to know which way to turn without the tests. It's likely that you have some vitamins deficient or very low, and if they are low they won't be helped much by ordinary supplements.
But also it may be that your thyroid hormones are quite high on 150, and that's why the raise made you feel hyper OR it could be the opposite, and your hormones may be quite low, and its adrenal problems or something else that is giving you the hyper feelings.
SilverAvacado, I am in Canada and can't find anywhere where I could order the tests myself. I am seeing an alternative practitioner tomorrow who I hope can help get the vitamins tested. It's D, B12, folate, and the irons, correct? I am going to a medi-clinic today and will ask for those.
I agree - without blood tests, it's hard to know what to do because I MIGHT not be over at all. I am pretty sure I am, and should know today. I wonder though what kind of effect my taking so little NDT over the last few days will have on the numbers though?
I am afraid I'm going to go hypo from so little thryoid meds, but I just can't seem to tolerate anything. I am going to ask for beta blockers and ativan today to help me get through. Do you have any experience with either of those?
Hi Evej13, I have never tried beta blockers myself. I have always been under rather then over. I know hyper people have had success with them, but I think there are dangers, too. So take as little as you can get away with, and you may be better off just burying yourself in bed and waiting for it to pass if you're able to
I agree that its possible you may not be over. It could be some other reaction that's making your body feel speeded up, like an adrenal issue.
The blood test you get will be a bit strange! It won't really tell you much about your current dose, but it will confirm whether you've got too much hormone in your blood stream right now.
Going to an alternative practitioner may be as good a way as any to get your own private tests Yes, folate, ferritin (stored iron), B12 and vit D are the ones we always recommend. If the practitioner is good they will hopefully have some suggestions of their own. I think adrenals are worth looking into, too, especially if you have a good person to guide you through it!
After experiencing being hyperthyroid and hypo I can honestly say that being hyper is far more fatiguing than hypo. At first you feel hyper and then your body gets super exhausted from being on overdrive. Can't sleep, hardly can eat, can't exercise or tolerate caffeine, feel weak and shaky, sweating all the time and believe it or not I gained more weight when I was hyper. From what I understand is that your body, being on a negative feedback system us that when you're getting too much thyroid it will start to shut down the thyroid pathway because it wants to save itself. Therefore you can start getting hyper and hypo symptoms at the same time. Maybe even 150 is a little too much for your body to handle...maybe try 120 or 130 when you get balanced again??
When I'm hyper, I have high heart rate, high BP, a different type of nausea from my hypo symptoms, a hot face, tingling arms, anxiety... I can sleep but I wake up at 5 (two hours early for me). Have no appetite, can't eat. I'm not sure what exactly I'll do when I'm balanced - I just want to get through today! Morning was not too bad. This afternoon, am feeling hyper again - high heart rate and BP (although not as high as yesterday), and horrible nausea...
Interesting about the negative feedback system.
Hi. So scary! The half life of T4 is 9-10 days for someone who is hypo. So in 9-10, the T4 you took is worth 1/2 it’s value. It slowly trickles off from there over the next 4-6 weeks.
Most importantly, bloods will gauge where where your FT3 and FT4 are now, and as you try to get stable again.
Hi ShootingStars. I got blood drawn yesterday. Will try to get results today and post them.
Oh! That's great! Crossing my fingers for you that they are not too bad.
Hi All,
I have my blood test results.
FT3 3.94 (ref 3.9 - 6.7)
FT4 15.9 (12 - 22)
Please keep in mind that this is after one day of 0 NDT, 1 day of 30mg NDT, 1 day of 60mg NDT. I had raised my dose from 150mg to 157.5mg for three weeks.
Was it thyroid at all? How much do symptoms lag behind blood results. Argh....
I think should try 90mg today and see what happens?
Has anybody tried beta blockers and ativan for these symptoms temporarily?
These are actually pretty low. Your freeT3 is right at the bottom of the range.
Unfortunately this is a bit of a confusing result if it was high we'd know it was definitely high. This is very low, so we know the amount in your blood isn't high. But it's still possible you might have higher amounts in your tissues.
I think this makes it a bit more likely that something else is the explanation, rather than the dose increase.
I suggest you make a brand new post, so more people will see this. Include the full story, these blood results, and the most recent results you had before this.
Hopefully people who gave experienced Hashis flares, and other similar things will reply to you!
Thank you. It's very confusing. I will make a new post.
Went to see another doctor. He ordered D, B12, Ferritin, Iron levels, auto-immune panel. Yayyyy!!!!
On another note. I took a mere 15mg this morning and had high heart rate and blood pressure within 2.5 hours, so it does seem related to what's possibly in my tissues??
Yea, it's very puzzling. Sometimes when people first start taking T3 they can have a reaction that feels like being overmedicated, and more rarely when starting T4. I think usually it's cortisol related, but could also be vitamin related.
I haven't heard of it happening after an increase, but that doesn't mean it can't happen.
The blood tests really are very low. It took me about 6 increases, which was about 3 grains, to get from the bottom to the top of the range. But everyone is different.
I am sorry I haven't been back for awhile. I've had a UTI plus an incredibly bad flu. I went back up to 150mg 15 days ago, and now am feeling panic attacks and heat flashes about 2 1/2 hours after I take my afternoon thyroid dose. Do I stay the course or drop to 120mg for a day or two?
I think the advice is the same as before. As long as you feel over medicated, it's okay to drop back.
Maybe a good strategy would be to drop back to wherever you reliably feel comfortable, and then then stick with that. Then start increasing towards your old comfortable dose super slowly. Try increasing by the smallest tablet you have, then hold on that for several weeks, and try to increase by that tiny amount again. At this point it looks like you may not be able to return to the dose you previously felt fine on, so don't assume that's the goal. Just do it slowly enough that you don't ever feel racey. Any time you do get the racing feeling again, drop back and stay at the lower does for a few weeks.
Since we talked before I've been reading more about similar problems. It's quite common to struggle to raise your dose even though you are undernedicated and need to increase. For you it's come on very suddenly, which is more unusual.
This is usually due to adrenal fatigue, but low vitamins also contribute. If your body doesn't have all these things in place then it can struggle to cope with increases.
I can't remember whether you've looked into these things before, and the thread is now enormous! But you need to make sure you get tests for folate, ferritin, vit B12 and vit D. These all need to be optimal, not just what your doctor is happy with. There's lots of info about these on the forum. Also get a 24hr saliva cortisol test. The ThyroidUK website has a lot of info about how to do this.
Treating those things, while increasing super slow should help.
Anybody have some ideas on how to support my adrenals? Pretty sure they're over-stressed.
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